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I grew up in a religious denomination that teaches not to defile your temple (body) with drugs like caffeine. It wasn't a "you're going to hell" prohibition, but it was certainly discouraged. As a result, I didn't learn to like the taste of coffee as a teen or adult. But my parents weren't all that strict about it, so I started drinking sodas with caffeine and had a serious Dr. Pepper addiction starting from about high school forward. It wasn't until I developed some benign cysts and my doctor inquired about my caffeine intake that I had ever even stopped to figure out how much I was drinking most days. (It was a LOT.)

Then came the day I discovered the Frappuccino® from Starbucks. That was heaven in a cup. With whip and drizzle. I was hooked. When I couldn't get Starbucks, I started drinking "regular" coffee with a lot of cream and sugar. Friends have told me I don't really like coffee, since it's not coffee when I'm done with it. It's a chocolate milk concoction with a little coffee in it.

I knew I was addicted. I have chronic migraine, and if I didn't have a good dose of caffeine by noon, I'd have a migraine headache by 3pm. The first neurologist Munchkin saw said that migraineurs self-medicate with caffeine and it can be a good thing. The next neuro she saw griped at both of us coming into his office with Starbucks. (We fired him.) The few times in my life I've tried to detox off of caffeine, it was 2 to 3 weeks of headache and fatigue and prescription doses of ibuprofen 'round the clock.

Nursing school and nurse life did nothing to dissuade me from continuing my caffeine habit. In fact, it's a standing joke that all nursing students have coffee in their veins instead of blood.

Then came my bariatric surgery.

My surgeon doesn't restrict caffeine after the 2nd day post-op, but a lot of people report not being able to tolerate coffee on their newly rearranged stomachs for periods ranging from a few weeks to a few months post-op. Knowing that coffee is pretty rough on the stomach, and since carbonated beverages and ibuprofen are completely prohibited for an extended time post-op, I knew I needed to get off of the caffeine. Withdrawal was not something I wanted to try while recovering from surgery and having a delicate stomach.

So a few weeks before surgery, I started weaning myself off of caffeine. It actually went pretty smoothly, with judicious application of ibuprofen and good migraine meds. By the time the surgery rolled around, I didn't need it anymore. I was "clean" for the first time in decades.

After the surgery, I didn't try coffee for a few months. I tolerated it fine when I did, but there was something freeing about not HAVING to have the caffeine in order to feel well. I also appreciated that since I didn't drink it regularly, when I did indulge in a cup, I got more of a "kick" from it than I had when I was drinking it multiple times a day. I decided I'd just continue with most days not having any caffeine.

Unfortunately, I'm also a Spoonie. Multiple chronic illnesses, most of them with symptoms of extreme fatigue and brain fog, cause me to struggle to get through many days. I started having occasional sugar-free caffeinated sodas with lunch. Then it became a daily thing. (Yes, my sleeve lets me have carbonation if I don't drink it too quickly.) A couple of weekends ago, I was feeling particularly sluggish and decided to get a soda. It picked me up so well that I had coffee the next morning and I had another really good day energy-wise.

I was faced with the choice of inviting my coffee monkey to climb right back up on my back or staying true to being "clean" and forcing myself to push through days without any support.

(Most people probably don't think about this kind of thing to the extent I do. It's one of my charms.)

I looked at myself in the mirror and said, "Screw it." Then I made myself a cup of coffee. Lots of creamer, monk fruit sweetener (that stuff is AWESOME).

Since we're starting to have warm weather here in Texas, I tried some cold brew coffee in cold milk with chocolate. YUMMY! That's my new morning staple until it gets cold again.

This past weekend, I forgot to get coffee when I got up Sunday morning, as the habit is not yet ingrained. Around 2pm I was trying to figure out why I felt so groggy and headache-y. I went to grab some food from the fridge and saw my bottle of cold brew and the light bulb went off. Got myself some coffee and felt better within the hour. (Yes, I'm a dork sometimes.)

Part of me felt bad that I'd succumbed to my addiction again after being well and truly free of it.

The part of me that loves my coffee knocked the other part into a coma and suggested we stop at Starbucks on the way home.

The reality I'm rejecting today is that I'm old enough to have a 21-year-old daughter.

Yesterday we celebrated Munchkin's 21st birthday. Facebook's On This Day reminded me that 5 years ago today, she got her driver's license. She then drove her Dad and I back to my house (he had insisted on being there for her driving test for some reason), kicked us out of the car, and took off for her first solo drive.

She's always been an independent person. I've alternately been grateful and annoyed by that trait in her. "My do it!" was probably her first complete sentence. (Actually, I'm pretty sure it was "Izzy is a stupid cat" but the other makes a better story.)

And of course, this is still how I see her:

But now she's an honest-to-goodness adult. She recently got her EMT certification, and last week finished her orientation for her first ambulance job. Oh, and she's moved out of the house again (though it'll be nice when all of her stuff manages to follow her). So I guess she's been "launched", whatever that's supposed to mean. I do hope that I gave her a solid enough foundation to make her way in the world without too many stumbles.

That's the thing about parenting that I sometimes think a lot of people miss. We're not raising children, we're raising people to be functional adults. Munchkin didn't have an easy go of things, with a single Mom for most of her life, and some really disasterous step-family stuff. So the self-sufficient streak was probably a really good thing through the years it was just me and her against the world.

I think I probably did a good job with her.

But I still insist I'm not old enough to have a 21-year-old kid. Just sayin'.

Dr. Young made the point that a condition is fundamentally different than a disease, and migraine is so much more than a headache. By using words like "migraines" or "migraine headache" we change the perception for ourselves and others and minimize a serious neurological disease. Also, using the term migraineur reduces the person to their illness much in the way the terms epileptic or schizophrenic do.

It's more than political correctness, it's about the perception these words create. I've used the term migraineur for years. Like other labels, it's simple and concise. I like simple and concise language, and have always resented political correctness being thrust upon me and my choice of language. However it's important for me to recognize the impact of the words I choose. This is like choosing to say rheumatoid disease instead of rheumatoid arthritis or psoriatic arthritis. The word arthritis dilutes the full impact and implication of rheumatoid disease.

Incidentally, I'm not trying to tell my readers or anyone else what words they should or shouldn't use. I'm just offering some food for thought, and offering an opportunity to think about the language you choose to use.

Part of my challenge in processing this is that I still tend to not think of migraine as the neurological disease and disability that it is. It's been just another fact in my life since I was a teenager. It runs in our family - my sister, nephews, and daughter all have it. Sis and I suspect our Mom has it based on our observations (though Mom disagrees).

I've written before that I never considered myself to have chronic illness until my rheumatoid disease was diagnosed. As I became more educated on the subject of chronic illness, I realized that I've lived with multiple chronic illnesses for most of my life. While my asthma is fully controlled with medication, I still have to make decisions in order to keep from having an attack. I cannot exercise in cold air without a mask, I cannot go to smoky environments, and I have to exercise caution when dusting or cleaning, and I can't go to concerts (second hand marijuana smoke has forced me to leave too many concerts early). I've had migraine attacks since my late teens, and it's affected my life to varying degrees ever since. Rheumatoid disease and fibromyalgia are just the two latest entries to my list.

So while I was still digesting and processing the information from Dr. Young's article, I watched the film Unrest (https://www.unrest.film/) and it reduced me to tears. It's available on Netflix and other streaming media. If you or anyone you love deals with chronic illness, I highly recommend that you watch this film, though I will warn you in advance it is hard stuff. It chronicles Jennifer Brea's experience with Myalgic Encephalomyelitis (ME) which has been associated with chronic fatigue syndrome. (Note: this association is disputed by some ME researchers.)

While the film is specifically about ME which I do not have, so many of the themes struck home with me, as I believe they do with all people who have chronic illness. People not believing us when we share our symptoms and struggles. Doctors telling us it's a mental condition (and even prescribing depression medication). Fighting to get referrals to specialists or specific testing. Feelings of guilt from placing burdens on our family and friends because of our illness, and of not "pulling our own weight". Relief when we finally get a diagnosis, even if it's incurable, because it means there's tangible proof finally. Grieving the person you once were and can never be again. Worrying about missing too many days of work, or not being productive when we drag ourselves in. Wondering if you will ever have a pain-free day again.

I've had to catch myself several times while typing out these paragraphs, as I tend to write that people "suffer" from chronic illness. This is yet again one of those words that changes perceptions. Certainly there is suffering that goes along with chronic illness. For some of us, it's intermittent. For others, it's fairly non-stop. But the term is passive, it's being subjected to something. It's like using the phrase "victim of" and while some people use it, others hate it. I don't embrace being a victim, even though the legal term applies. Similarly, I don't embrace suffering from anything. I prefer more active terms. I survived abuse, I fight chronic illness. It's also important to recognize that some people don't like the active verbs, either, and find being labeled a "fighter" or a "warrior" demeaning. Dr. Young probably offered the best advice, in that we can use any term we want when relating our own experience, but we should try to avoid applying labels to other people as only they define their experience.

The biggest word I struggle with, however, is "disability". When I think of someone with a disability, I think of wheelchairs, canes, severe impairment of a sensory system like sight or hearing, or like some of the people in Unrest essentially being bedridden. I have a strong aversion to calling myself disabled or saying that I have a disability. Part of my resistance is because I don't want to minimize what those with the more severe impairments deal with. I am still able to hold down a full-time job. I recently finished a master's program while continuing to work full-time. That doesn't fit the picture in my head of someone with a disability. Never mind that while doing that, I was completely unable to keep up with even minimal housework or cooking, and every weekend was spent recuperating from the week before. Part of it may be a fear that someday the impact on my daily life will be much more severe.

Perhaps the other thing about words is that while they can change perception, we can maybe create a change in how certain words affect us and others by changing the dialog around them. Especially when dealing with hidden or invisible disabilities, talking more about them and how disability is on a continuum can change how we and others see the concept.

There's one word I won't give up, though. Spoonie. The story by Christine Miserandino (https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/) in which she explains to a friend what it feels like to have lupus has given all of us who deal with chronic illness a touchpoint around which we have built communities of support for each other. It gives us a shorthand to use with each other and our allies. It might be reductive, but for me it's an identity within a community and that's an important thing to have, especially when you have a chronic illness.

I spent a few months as a client of Good Measures, and wanted to share my experience.

The short version is that Good Measures is a great service, especially for bariatric surgery patients who do not have easy access to a Registered Dietitian (not a Nutritionist) where they live.

For those not familiar, Good Measures essentially provides dietitian services over the internet. You track your food in their diary setup, and your macro- and micro-nutrients will be evaluated. The tools are available through the website or a mobile app. You get immediate feedback in the form of the Good Measures Index (GMI), a number from 0 to 100 that evaluates the quality of your food intake for the day.

Each client is also paired with a Registered Dietitian (RD) for individual meetings over the phone, up to once a week included in the monthly fee. The RD can make adjustments to your individual nutrient goals to better reflect your needs. For instance, mine ramped up my protein goal and decreased my carb goals as I am a bariatric surgery patient. During the weekly meetings, the RD gives suggestions for foods to expand variety or better address nutritional needs/goals. The website/app also gives meal/food suggestions including recipies from several sources, and you can choose which of those sources to use as well.

I read about Good Measures in the Bariatric Foodie blog and she reports that Good Measures requested her input to make their platform more helpful for bariatric patients. Her blog entry has a MUCH more detailed review of Good Measures, I recommend checking it out. I also found them to be very responsive to input about their product and services.

One of the challenges for the bariatric surgery patient is finding really good dietary information. Physicians don't tend to get a lot of training in nutrition during their schooling. What a bariatric surgeon knows about diet typically comes from his perceptions of the experiences of his patients, plus information he gets from his peers. As a nurse, I got more training in nutrition than most physicians, but it's still not anywhere near the level of training a Registered Dietitian has.

A word here about nutritionists, those we refer to on WLS boards as 'NUTs'. In my state, and probably most others, there is no required training, certification, or degree in order to call yourself a nutritionist. Literally anyone can hang a shingle and call themselves one. I would imagine some NUTs are great, somewhere. However, I've never met one. What I have gotten from NUTs include information copied straight from the American Dietetic Association, exchange diet information that's outdated, or some wacko fad diet that's all the rage. Oh, and they usually want to do blood tests on the order of several hundred dollars to inform me what I should eat based on my blood, and identify food allergies that are "sub-clinical". I'll spare you my rant on this quackery, since my use of the word 'quackery' should make my opinion plain.

Bottom line, in my honest opinion NUTs are rarely worth your time or money. If they are employed by a surgeon's office, they'll be handing out the same information to everyone with little to no customization for individual needs and no real critical thinking if asked a question outside the box. If they're in an independent office, expect a lot of billing for information you can easily get from the internet and most of it is likely bunk. Often, NUTs are all a bariatric patient has access to, and that's a problem.

I loved that Good Measures provides access to a RD instead of NUTs, and that they've made a concerted effort to improve their offerings for bariatric surgery patients. I found my RD very easy to talk to, and she was very helpful.

My only complaint is that I found their food diary program to be not quite as robust as MyFitnessPal, and a little less intuitive. I don't mean to say that their database is bad, it's actually pretty good, it's just not quite as robust as MFP. I believe that they're working on expanding their food database, and help is always available through email or phone with a helpdesk technician. It was not annoying enough to drive me away from the service. On the plus side, the food diary looks at more micro-nutrients (vitamins, minerals, etc.) than MFP does, and the GMI is a real benefit. Add that to the RD access, and the little gripes I have about their interface are minor.

In comparison to what consultations with an in-person run, it's an absolute steal. The costs when I was on the service were $39/month paid monthly or $29/month paid annually ($348/yr). While that's more than a Netflix subscription and might seem high, I found it absolutely worth it. Especially for bariatric surgery patients who don't have ready access to a RD, this service is indispensable.

There is one caveat I think I should mention. If you have not been released to a "full diet" by your surgeon, you need to continue with what he/she has prescribed. During that critical healing period, what your surgeon says should be what you follow, period. (I have an entire post dedicated to the subject here.)

I think Good Measures offers the most to bariatric surgery patients who are moving into maintenance and want to expand their diet while still focusing on quality nutrition and trying to avoid the weight "bounce" that's very typical for many patients. It might also be an excellent choice for those around a year out who may still be trying to lose weight, but are finding it harder and harder as the honeymoon period wanes.

I did drop my service after a few months, because all the stress of grad school and chronic illness flares during the winter left me without the energy or drive to spend the time and money on my dietary quality. I will probably pick it up again later when I'm actually ready to focus on the effort.

Conflict disclosure: I was not compensated in any way for this review. I paid full price for my Good Measures service, and was not asked to make this post by anyone.

So it’s a new year. I’m always struck how this arbitrary line in time is given so much importance. I mean, it makes sense. But then it doesn’t, really. Resolutions are made and rarely make it past the first week of the new year, but we still do it, year after year. Wipe the slate, start over, good intentions and plans for better outcomes. Until we “fail” and then it’s forgotten until the next New Year’s Eve/Day.

I’ve tried to stay away from the whole New Year Resolution thing for years because I believe it sets us up for failure. Instead, I’ve tried to embrace the idea of choosing a theme for the year, and focusing on that.

Of course grad school, coming to grips with chronic illness, changing jobs, weight loss surgery, and other changes for the past few years has demanded my attention and focus, and even yearly themes have been something I’ve lost track of as the year progressed.

2018 feels different to me, and I think it’s because it’s really a time of change for me. I finished grad school mid-December. I started looking back and realized that I’ve been in school almost non-stop in addition to work and family, for basically the last 10 years. It’s been a decade since I’ve had significant amounts of free time, so this is all unfamiliar territory for me. When invited to join things, or when I’ve had an interest in an activity or hobby for the last few years, I’ve said “yes, in 2018.” Well, 2018 is here and I have quite the list. I can’t do everything that has interested me, but I do have some things to start with.

So I’ve decided the theme of 2018 is going to be Renewal. Renewal of hobbies and interests. Renewal of career momentum. Renewal of relationships with the people most important to me. Renewal of my self-care program. Renewal of my physical health initiatives.

So Happy New Year, and I share this quote from Neil Gaiman as my wish for all of you:

I used to participate on a particular WLS support board, and we had an absolute deluge of people posting about “cheating” on their post-operative diets. Some of the netizens would respond “oh, honey, that’s okay… we’re all human.” Discussions about how impossible it is to fight food addictions would ensue. As a nurse, I was horrified that these people did not seem to understand the critical importance of following the post-operative diet instructions from the surgeon.

In case this post runs on too long and you need the TLDR; (too long, didn’t read) version here it is: STICK TO YOUR SURGEONS POST-OP INSTRUCTIONS TO THE LETTER. IT IS NO LESS THAN YOUR LIFE ON THE LINE.

Understand your surgery

Most bariatric surgeries today are performed arthroscopically. That means there are only a few tiny holes that you can see from the outside. You need to understand that the surgery on the inside is HUGE. If you’ve had the vertical sleeve gastrectomy (VSG) there is a suture line running the entire length of your stomach. If you’ve had Roux-en-Y (RNY) also known as the gastric bypass, there are multiple suture lines throughout your digestive tract. There are other surgeries, but those are the main ones, and the principles hold for all of them.

If you had a long cut on your arm, you’d (hopefully) know that you need to keep it clean, keep out dirt and other stuff that can get stuck in the wound, and how important it is to protect the area while it heals. You can’t see the wounds that are on the inside, but they require the same kind of protection and support while healing. But we can’t put bandages on them, or keep from eating. So food is going to be in contact with those healing wounds.

Also, whichever surgery you had, your stomach has a new configuration and doesn’t know how to manage food easily just yet. Your digestive system has to re-learn how to do its job with the new configuration, just like a newborn baby’s. It’s important to start easy and work up to harder to digest foods.

A diet for healing

Any food you eat while the suture lines heal (about 6-8 weeks) will be in contact with a healing wound. Most surgeons give very detailed instructions about what to eat after WLS, and it’s all designed to protect that suture line and ease the newly configured stomach into its new way of working.

Over the years, doctors have learned what foods are best for a healing stomach, and that translates into the post-op diet progression instructions. Typically, that looks like this: Clear liquids, full liquids, pureed foods, soft foods. Each phase typically lasts a week or two. Only after those phases are complete will they have the patient slowly move into a "full" diet beginning with high moisture content foods first. The surgeon will specify what foods belong in each phase, and how long to stay in the phase.

The general idea in the very early weeks is to eat foods that will not stress the healing suture line, and do not have particles that are known to cut into the raw tissue or get embedded into the suture line. If a cut or embedded food particle gets infected, it can become an abscess and develop into a life-threatening leak. Foods that are particularly known to cause issues are those that swell up like rice, have seeds like strawberries, or have rough hard edges or hard to digest fibers like wheat crackers or raw vegetables.

When moving from one stage to the next, it's typically advised to add just one food at a time, in small amounts, and see how it's tolerated. A food that's not tolerated well can be tried later on as well. If an entire stage is not being tolerated, back up to the previous stage for a while, and then try again more slowly. For example, eggs were on my soft foods list, but I couldn’t tolerate them until after I was eating moist proteins. My surgeon said that was common, and many food intolerances early on will clear up later after more variety of foods is well tolerated.

A very real risk

Just as there are people who smoke a pack a day while drinking a pint of whiskey and live to be a hundred, there are people who eat all sorts of things against their doctor's orders and suffer no ill effects. This is not a justification to ignore your surgeon’s instructions, it’s pure luck on their part, or possibly some amazing genetics. You shouldn’t count on either.

The reality is that some people will develop abscesses and leaks because they ate things before they were cleared to by their doctors, and there is no way to predict who will have the complications and who will not. And the consequences can be as severe as death.

I don’t say this to scare you away from WLS. These complications are very rare. But you increase the risk significantly when you ignore your surgeon’s post-op instructions. The doctors are not testing you or trying to make your life hard. They are giving you the best information they have to keep you safe.

It’s incredibly difficult to deal with cravings or “head hunger” as some of us call it, or wanting desperately to chew real food. It’s very hard to be on liquids only for weeks. Acknowledge that it’s hard, and seek support in getting through it, but understand how vital it is to muscle through. Violating these orders is not "cheating" on a diet. It's risking your life.

Trust your surgeon

If you spend any time talking to other WLS patients, you’ll find that every surgeon has a slightly different protocol. Some skip entire phases listed above, or shorten them dramatically. Some seem to be completely radical and start patients back on solid food in just days after surgery. This is not a case of right or wrong. Each surgeon operates based on what they were taught combined with their personal experiences. They may even make modifications for an individual patient based on that patient’s health and history.

If you are trusting this surgeon to operate on you, then you need to have trust in their protocols. The time to make sure you fully understand the protocols, have documentation about the specifics of the protocols, and that you agree to the protocols is BEFORE SURGERY DAY. If you don’t trust everything your surgeon advises, get a new surgeon. If there’s a particular concern about part of a protocol, sort it out before you schedule the surgery.

I personally would never stay with a surgeon, for instance, who doesn’t allow any protein drinks (even clear ones) for 2 full weeks post-op. (Relayed by a patient online, I don’t know if it was truly in the plan.) I know from my training that healing requires lots of protein, and a huge amount of the healing happens in those first 2 weeks. If that were in a surgeon’s protocol, I’d get a referral to another.

In conclusion

WLS is a fantastic tool for many people in retaking control of their health. It’s a huge commitment. Do yourself and your surgeon a favor, and don’t risk all the time, energy, and money you’ve put into it. Follow your instructions. Believe me, it’s over faster than you know, and it sets you up for success in the rest of the process.

Time to look back and see how the year went, and try to decide what’s important for the upcoming year.

2017 has been a rough one, certainly. I think the country made a mistake with the election of #45, and I find him to be a complete embarrassment. I believe we’ll be cleaning up his mess for the rest of my natural life. I find myself anxious and upset over politics and political maneuvers every single day. It doesn’t help that our representatives in Congress don’t seem to care about the lives of their constituents, only the grift lining their pockets. I know it’s been that way for a long time, but it seems to be getting worse and worse since Citizens United. I honestly fear for my country.

On a personal level, it’s been a year with ups and downs, but mostly ups.

Since having the weight loss surgery in August of 2016, I have lost approximately 110-115 lbs. This has resulted in vast improvements in my health overall, and likely contributed to my auto-immune condition going into remission this year. My health news hasn’t been all good, though. I developed thyroid nodules and a host of odd symptoms that seemed to resolve after stopping my auto-immune medication. I also was formally diagnosed with fibromyalgia. The fall/winter brought a string of migraines and respiratory problems, and that seems to be a seasonal pattern for me. With all of that, plus grad school, my weight loss has stalled out about 15-20 lbs away from my goal. I’ve been able to maintain pretty well, which is good. Once the winter-related health issues start resolving in the spring, I’ll hopefully be able to get that last 20 lbs off.

Ah, grad school, how I loved thee… NOT. I am happy and proud to say I slogged through my last semester of grad school, and passed with a GPA of 3.57. I got seriously behind with the capstone project due to health complications, and lost a lot of points in my topics class due to late postings as I tried to keep up. I seriously considered abandoning the semester and trying again in the spring, but good friends and family convinced me to push through. My capstone professor was flexible with it and helped me catch up, which I greatly appreciate. I am SO happy to have it done now, and so glad people who care about me convinced me to push through.

Now I have 2018 upcoming, which was the year I told everyone I’d get back into a social life. I have so many things that I wanted to do that I had to shelve until 2018, so now I have to see which ones I still want to do and what the priorities are for all of it. It’s strange to have free time again and not worry about assignments or reading that I’m behind on all the time.

On the homefront, the Mister and I continue to be blissfully (and annoyingly according to Munchkin) happy together. After getting it so badly wrong a couple of times, it’s still a wonder to me that I got it completely and totally right this time. I truly feel blessed. All our kids are doing great. We did gain a new fluffy member of the household when a young tuxedo tomcat invited himself in on a chilly evening. I posted to the neighborhood boards and no one claimed him, so George became a member of the family after getting vetted and fixed. Princess Buttercup is decidedly NOT amused, Ginny is alternately interested in playing and ticked off about him. The dogs don’t know what to do with him, especially since he keeps trying to go into their area of the house. But it’s fun having a young boy cat in the house again… he demands playtime or he gets truly obnoxious with the other cats, and he CLIMBS EVERYTHING.

Well, that’s most of the update for 2017. I’m planning to do a lot more writing in 2018, so stay tuned for that.

I'm in the final countdown for #gradSchoolSucks -- 3 weeks left. It's hard to accept the fact that I'll no longer be a student a month from now.

Well, IF I get my paper done for my Capstone and I don't flake on the rest of my Topics units.

I am imagining all the things I'll get done with all that spare time. And then laughing at myself, because most of it will assuredly be spent catching up on my reading list and Netflix binging.

But to have a life again! Woohoo! 5K's, dance lessons, learning languages... I have a list of things I want to start or take up again in 2018. Whether all of them will happen or not is anyone's guess. I just won't have the crush of grad school pressing on me.

In a way this feels like a brand new start on life. Even though I still struggle with chronic illness and everything that goes with it, I'm so much healthier than I was when I started back to school all those years ago. I even broke another weight plateau this morning, putting me only 5# away from the top of my ultimate weight goal range, and 15# away from the low point of the range. I had been only marginally watching my intake, and haven't been terribly active with all the migraines, allergies, upper respiratory infections, and such that seem to be my life in October/November each year. I'd resigned myself to maintaining my weight until after the holidays. So anything that comes off on its own is a fantastic bonus.

So right now I'm still in the tunnel, but I see the light and all I have to do is keep moving and I'll get there.

If you can't fly then run,
if you can't run then walk,
if you can't walk then crawl,
but whatever you do
you have to keep moving forward.
― Martin Luther King Jr.

The "on this day" feature of Facebook has made it clear that October is migraine month for me, and this month was no exception. In fact, my migraine monster decided to go for a personal record. I had three weeks straight at the end of September and beginning of October where I didn't go a single 48 hours without a migraine or other severe headache. I finally determined that sinus pressure, partially due to crazy weather changes, was playing a part, along with a bit of dehydration from the constant pain. Munchkin's first neurologist (who was a Godsend) said migraineurs cannot let themselves get hungry or thirsty or they risk a headache. Wiser words were likely never spoken. I signed my life away at Walgreen's for some real Sudafed, upped my water intake, and along with several rounds of a version of the ER Migraine Cocktail, finally got the cycle broken.

The #meToo wave crashed over Facebook, and I felt moved to share a little bit of my experience. This caused me to publicly state some things that went on in marriage #2 that I'd never spoken of publicly. That required a lot of emotional processing, and I'm currently re-evaluating people who remain in social circles with both Ex#2 and myself. I think it was worth it, as a couple of guys on my friends list posted that the #meToo wave showed them in perfect relief something they'd never realized before. That virtually every woman they know had suffered some degree of sexual harrassment, assault, or abuse in their lives. I really hope that this is the beginning of a sea change in the way we talk about violence against women.

I'd like to point out that I'm being gender specific with my terms, because the violence is also perpetrated against non-binary and trans people when they present or are percieved as female, so I have not changed my wording because I believe that this particular violence is against women specifically. Non-binary and trans people face ADDITIONAL violence because they are not conforming to societal gender norms, and this is equally wrong. I don't like conflating the issue because it dilutes the impact of the violence against women, and it also erases the idea that non-binary and trans people who present or are perceived as female get TWO kinds of violence directed at them. I also recognize that men are victims of sexual harrassment, assault, and abuse as well. They should also be believed and supported, no question. But again, I don't like conflating issues and want to see violence against male targets given its full due.

Anyway, enough social commentary for today. LOL.

Work is stressful. Grad school is stressful. I told my therapist last night that I think I've maxed myself out on stress. It's causing me to procrastinate with school stuff making this last semester that much more of a grind and adding more to the stress levels. It's causing me to become ambivalent about projects at work, which is never a recipe for my best effort and results.

In good news for the month, I'm back to my regular dose of the fibro meds, and my daily pain level is a 2-3 out of 10 which is a vast improvement from the 5-6 it was earlier in the year. My fatigue is getting better, but then I'm still recovering from the beating October delivered to me. I still hate having a fibro diagnosis because it's so non-specific and has a lot of stigma attached to it, but I have to be glad that I'm in the percentage of people for whom the meds seem to work well.

So I have basically seven more weeks of grad school to gut through, and then I'm hoping life gets a lot happier. In the meantime, I'm hanging on and pushing through. Now that the weather is starting to level out as Fall blows in, I'm hoping that November will be a lot better of a month for me.

It seems like every time I think I’m starting to make real forward progress, something sets me back.

I mentioned a few weeks ago that I was pretty sure my rheumatoid disease was not, in fact, in remission as Dr. B seemed to think. My joint pain had been steadily escalating since spring, with some new joints joining in the fun.

However, my blood tests show zero elevation in any of the inflammatory factors, and there is zero visible swelling in my joints. So I asked the nurse who called with the results what Dr. B thought might be causing my now 5/10 pain level. She called me back later to let me know Dr. B thinks it’s “the fibro”.

The WHAT?

No one had ever talked to me about a fibromyalgia diagnosis. I knew that I probably met the criteria for it, but it fully depends on self-reported information about pain and impact on daily activities. So pretty much anyone who reports widespread pain with a negative impact on daily activities without another diagnosis found, gets a fibro diagnosis. It’s the bucket we all get thrown into if we keep insisting we hurt and the docs can’t find anything else. Medically speaking, it’s a trash-can diagnosis. It doesn’t help that frankly some people take advantage of the self-reported nature of the diagnostic criteria in order to gain sympathy, pain medication, and even disability income.

At any rate, the nurse said the doc wanted to put me on Cymbalta and Gabapentin. I’ve had trouble with Cymbalta in the past and told the nurse that I’d been on Savella for fatigue because of my past issues with Cymbalta. She brightened up and said that Savella was even better, and since I’d been on it without issue, we’d just start it up again. After I got off the phone, it occurred to me that I’d tapered off the Savella right about the time the pain started up, so it lent credence to Dr. B’s assessment.

So I’m ramping up my Savella doses again, and the pain is lessening. So I guess that I really do have fibromyalgia, and I’m lucky in that there’s a medication that helps. It’s a med I tolerated well, which given my history of side effects and adverse reactions, is a minor miracle.

I’m also finding that if I can drag my happy butt off the couch and go swimming or walking, I do feel better as long as the exercise is not overly strenuous. It’s the dragging myself off the couch when I feel like hammered dog poo that’s the challenge.

I even managed to finish my first 5K with my new weight loss surgery support group. The Mister did it with us, and my time actually puts me in the acceptable pace rates for many of the popular 5K walk/runs. Part of me wants to start doing them periodically, but part of me doesn’t like the thought of joining huge crowds of people to walk 3.2 miles. Once grad school is over, we’ll see what I have the time and energy for.

This forward and back pattern is discouraging but as the quote says, if you look at it right it’s a Cha-Cha. I guess the trick is to keep finding ways to move forward, while finding the right music for the dance.